Lydia Peckover is a Northwest Family Life affiliate therapist working with children, teens, parents, individuals and couples. Her specialties include trauma and PTSD, behavioral issues, and life transitions. She often works with art / play therapy, EMDR and DBT skills.
Research shows encouraging results around art / play therapy, especially when compared with talk therapy. Can you talk about this?
Dr. Karyn Purvis states, “Scientists have recently determined that it takes approximately 400 repetitions to create a new synapse in the brain -unless it is done with play therapy, in which case it takes between 10 and 20 repetitions!” To put this in perspective talk therapy requires about 400 instances of talking about the new habit before the brain creates a new connection to exhibit a new behavior with more ease. That is more than a year of weekly sessions! Play therapy would take about 10 to 20 sessions before the brain would create a connection to do the new behavior. Why? Because the brain is more active when we use a sand tray, play, art, music, movement, and/or creativity. This research encourages people to be more open to using play therapeutic techniques in therapy, such as a sand tray.
About half of your work is with children. Can you tell us what happens in sand play?
A sand tray is an Expressive Arts and Play therapeutic technique. The goal is to express your thoughts in the sand. The person (of any age) creates a story in the sand using miniature characters, objects, etc. This form of play therapy is a way to see our thoughts (or the story) as objects in the sand, and it helps to organize our thoughts to help us feel better. A sand tray helps all ages and can be used with dry sand (trauma sensitive) or wet sand, using warm water.
You also use expressive arts therapy with adults. How is using art to access different parts of the brain effective?
Expressive Arts is a way of communicating without necessarily using words. Brain scans have shown more activity in the brain when using creativity, art, music, and movement than when a person is using speech alone. I use somatic experiencing therapeutic techniques, expressive arts, and even “sessions while walking” in therapy because I have seen that when people use more areas of the brain in therapy it speeds up the healing process. Our brain naturally wants to help us heal, we might as well allow more areas of the brain to participate in therapy!
You do a lot of work using dialectical behavior therapy (DBT). Can you tell us about the skills that DBT teaches?
The four types of DBT skills includeMindfulness (being present to experience what’s happening now as a way to take a break from worrying about the past and future), Distress Tolerance (Dr. Marsha Linehan describes it as “how to survive the crisis without making it worse” and skills to “accept”), Emotional Regulation (understanding emotions and using skills to maintain a balance), and Interpersonal Effectiveness (people skills). Many people I work with tell me they like to learn DBT Skills because each skill is described simply and it’s like having an instruction book on how to live a better life.
Who can benefit from utilizing DBT skills?
Everyone, young or more mature, can benefit from using DBT Skills. This is a behavior therapy that helps us change behaviors to “live a life worth living” and to “reduce pain and suffering.” (quotes by Dr. Marsha Linehan, founder of DBT.) I use DBT Skills with children, teens, adults, parents and mature adults. Parents find helpful skills to parent more gently and effectively. DBT is an evidenced based practice for suicidal ideation, bipolar disorder, borderline personality disorder, depression, anxiety, and trauma/PTSD (Post Traumatic Stress). DBT is well researched and proven effective with addictive behaviors as well as preventing nightmares, sleep disorders, grief, schizophrenia, and many other mental health disorders. People who are suicidal come in for DBT Skills therapy because of the pain of living. I have seen many begin to use DBT Skills and begin to participate fully in life.
Tell us about your work with EMDR trauma therapy and how it can heal trauma wounds.
EMDR therapy, founded by Dr. Francine Shapiro, uses the Adaptive Information Processing (AIP) theory; it is our body’s natural tendency to heal itself. For example, with a bacterial infection, our body automatically works to heal the infection. Using the AIP theory, EMDR therapy’s goal is to activate the brain using bilateral stimulation (left and right sides of the body) with either eye movements, sound or touch (like tapping) so the brain can be fully on board to reprocess stressful/trauma memories.
These memories are stored improperly in the brain and cause a trauma response. After EMDR therapy people have found results such as lack of distressing thoughts, emotions, and body sensations. Here is an example of healing traumatic body memories: A survivor of domestic violence has discomfort in a new relationship because they cannot be touched without being triggered by a body memory from past abuse. After using EMDR therapy, this person has reprocessed the body sensations and has no body triggers. This person can be touched and feel the natural feelings of safety and healthy attachment in the new relationship.
EMDR therapy is an evidence-based practice for PTSD (Post Traumatic Stress Disorder). It has been shown to effectively relieve anxiety, depression, chronic pain, migraines, addictive behavior, grief, insomnia, and more. Some therapists listen for negative beliefs in therapy as an indicator of who can be helped by EMDR therapy, because they believe the anxiety, depression, pain, etc. were likely caused by the negative beliefs about themselves.
Negative beliefs such as, “It’s all my fault,” “I have no control,” or “I’m not safe” are formed at the same time as a stressful situation or traumatic event. The goal in EMDR therapy is to create positive beliefs. Holding positive beliefs about one’s self can reduce trauma responses such as depression, anxiety, unexplainable pain or sickness, overreacting or feeling numb, feeling triggered, memory absences, avoidance, nightmares, etc.
Many people have said EMDR therapy has fast results, especially in children and teens. EMDR therapy can be used with other therapeutic techniques such as Attachment Focused therapies, Expressive Arts, Somatic Experiencing (body work) and Play therapy. There is a need for assessment and preparing people for EMDR therapy. DBT Skills help prepare people to stabilize behaviors so they are ready for trauma therapy such as EMDR therapy.
Talk to us about “Installing a future template.”
EMDR therapy provides many therapeutic techniques that help therapists become more effective and efficient. EMDR therapy works on the past, present, and future. Installing Future Templates is an EMDR therapeutic technique that helps therapists see how the person would handle stress in the future. Installing a Future Template also identifies any developmental gaps. For example, if a person experienced a medical trauma, child abuse or substance abuse (such as drug use) in their teen years, this traumatic event could stop or delay development. The adult may need skills to be able to understand their own identity or have difficulty solving problems on their own because they were unable to learn these vital developmental skills as a teen. So we would work on those skills in therapy. Installing Future Templates is a quick check-in and helps a person assess ability just by asking a few questions.
You also work with couples. Tell us about using Gottman skills and DBT skills in this work.
Many times couples ask for the Gottman therapeutic techniques in therapy because of it’s great results. I have found many couples need steps before jumping into using Gottman’s techniques. DBT Skills can be used as steps to help couples understand how to communicate better in a relationship. For example, DBT skills such as the GIVE skill (be gentle with yourself and others, act interested, validate the valid, use an easy manner) can be used to build healthy relationships or the FAST skill to keep your self-respect in relationships. These Interpersonal Effectiveness DBT Skills may be used with Gottman’s “Four Horses of the Apocalypse,” the predictors for divorce (Defensive, Criticism, Contempt, Stonewalling). Also, sometimes therapies can cause a trauma response in those who are trauma sensitive. This is why treatment plans in therapy are unique and tailored to the individual and/or couple’s needs. Some find DBT Skills as a more trauma sensitive approach for couples, yet there is such an effective framework provided by the Gottman Institute. For couples, I like to use both Gottman techniques and DBT Skills.
In your work with families, you’ve said that a big part of it is teaching parents how to calm down. If the parent can self regulate, what can follow?
When the child’s environment is calm the child can work on issues causing distress and engage in trauma work. As the child or teen does their therapy, I continue to work with parents toward healthy attachment with their child and what is developmentally appropriate.
How can trauma affect developmental stages?
Trauma responses include fight, flight or freeze modes. Reliving the traumatic event can mean living in one of these states, in other words, a pretty intense survival mode. These high levels of distress cause our brain to focus on surviving the danger and development is put on hold. An example is a child who experienced early childhood trauma and has speech delays. Later on, the child needs support to develop speech.
Another example is if a person experienced a medical trauma or substance abuse (such as drug use) in their teen years. This traumatic event could have caused their development to stop during the time of danger and could cause a gap in their development. As an adult, they may need support to be able to understand their own identity or have difficulty solving problems on their own because they were unable to learn these vital developmental skills as a teen. So we would work on those developmental skills in therapy.
You can connect with Lydia via her website, https://arisewellcounselingservices.com
Tyler Ziebarth is a Northwest Family Life affiliate therapist who often works around issues of trauma, addiction, anxiety, and toxic beliefs.
Talk to us about humanity’s innate drive to grow.
This is a deep belief that I hold about people: that we all have an innate drive towards growth and development. Our natural movement is towards wholeness and “largeness”, that is, occupying a larger sense of who we are and our worth as individuals. Carl Jung once said, “We all walk around in shoes far too small for us”. By that I think he meant that the roles we play and the scripts we have been given by family and society are not large enough to contain the beauty and potential each of possess at our core.
So many problems arise when that movement towards our largeness is stifled in some way. This can occur either from things that happen to us (trauma, abuse, etc), or things that should have happened but didn’t (empathy, validation and attunement from caregivers). But no matter what happened (or didn’t happen) to us in our lives, it does not negate or destroy that inherent summons to grow and expand.
In fact, sometimes the “stuckness” we feel in our lives is our soul’s way of alerting us to places where growth and largeness are being stifled. If we have ears to hear and a sense of curiosity toward our symptoms, they may actually have much to teach us about what we need in our lives to become more fully who we were intended to be.
How might someone’s relationship to food or sex reflect how they relate to the world?
Sex and food have much in common. Both have a lot to do with longing and desire, the hunger for connection with self and others, and an appreciation of the body and its capacity for sensual pleasures. Sex and food are both ways we bring our bodies pleasure, a sense of comfort, nurturance, and care. How we relate to sex and food reveals much about how we are in relationships with others as well.
If you think about it, food was also one of the first ways we learned to soothe intolerable internal sensations. We felt the pang of hunger as an infant, and our mothers responded by feeding us. It was also in these moments of feeding that we were simultaneously being relationally satiated, having the experience of our caregiver attuned to our hunger for both food and relationship. No wonder sex (longing for relationship) and food become emotionally charged issues later in our lives.
It makes sense that if we have not developed internal resources for coping with stress, or the unpredictability of life, that we return to these early forms of self-regulation, often with extreme and unhealthy consequences. So though food and sex can offer us ways to bring our bodies pleasure and a sense of comfort, they can also become areas that bring contempt, condemnation and pain when we do not have other means of soothing our hearts.
Why might one want to develop the ability to tolerate anxiety?
For better or worse, anxiety always goes hand and hand with growth. The ability to tolerate anxiety is a prerequisite to growth. The hard truth is that the extent that we avoid and escape feeling anxiety is the extent that we also sacrifice our growth and development. Anxiety is uncomfortable, especially for those who have experienced any sort of trauma in their lives. But, as is the case with most of our anxiety-avoidance strategies , they hinder us moving forward in our lives. As the old adage goes, “what we resist persists,” and I would add, grows bigger and scarier.
Healing requires tremendous courage to face the monsters of our past and grow in our capacity to tolerate these states of anxiety. We learn how to attend, befriend and regulate our anxiety, rather than letting it rule our lives by constantly avoiding it or becoming overwhelmed by it. This is where working with a therapist can be helpful in offering the support, attunement and containment, often required to step into these places.
Talk to us about dysregulation.
Dysregulation is a form of losing your emotional balance. This is what happens when we get over the top stressed and our nervous system goes into overdrive. At this point our bodies are flooded with stress hormones and we lose access to the thinking part of our brain. For some this emotional hijacking can feel like you are drowning in your emotions. Or, for some it feels like going into “shut down mode” and they experience an absence of feeling, or numbness.
Either response hinders our ability to think straight and respond to the situation with the necessary flexibility and wisdom required to navigate the complexities of life and relationships. When our nervous system is going haywire, we naturally turn to anything that will help calm us down and rebalance us. This is where potential problems arise. If we have not developed the internal resources necessary to bring our systems back to a state of goodness and calm, we will inevitably outsource this job to a number of external things and/or behaviors (food, sex, tv, over-work) with potential negative consequences.
How might extreme trauma require a witness to stand beside someone as they work through overwhelming states?
The overwhelming states that trauma survivors talk about are sometimes called “body memories”. It is well documented that traumatic memories are often held in the body and experienced by survivors as overwhelming physical sensations. When the memory remains unprocessed, the body acts as if the trauma is “happening now” rather than something that “happened then”.
In other words, even though the thinking part of our brain knows the trauma happened a long time ago in the past, when a reminder of the past triggers us in the present, our thinking brain shuts down and our bodies act as if the trauma is happening all over again. At this point the person’s body is completely hijacked by terrifying physical sensations similar to what they experienced in the past. It is as if that young part of them who experienced those terrifying experiences back then is still very much alive in the present. The body, and subsequently those younger parts of us, get tagged as the source of terrifying sensations and are avoided at all costs.
Part of the work for trauma survivors is to reconnect with those young traumatized parts of the self and offer the care, attunement and containment they originally needed back then. Those younger parts need someone older, stronger and wiser to see how bad things were back then, and offer the appropriate care and protection that was missing. I often tell my clients that those panicked, triggered parts of us need to know that “someone gets it”, in order for those parts to move forward and heal. The therapist may be the initial witness to the client’s story, but over time the client becomes empowered to become that witness for their younger selves.
Tell us a little bit about different parts of the self, especially the younger parts and how they grow.
The writer Madeleine L’Engle once wrote, “I am still every age that I have been”. I love that because I think it speaks to the reality that we are not a single “self”, but all are made up of many parts of self. I think we all intuitively feel this, and it is especially evident when you hear people say things like, “part of me wants to do this, but another part wants that…”. The Pixar movie “Inside Out” is another great example of this theory of multiple selves. How many of us can recall feeling younger than we are at certain times of frustration or disappointment, or when we visit our childhood homes during the holidays? The path of growth and maturity requires that we learn to attend to and work with these younger parts of ourselves when they get activated.
This is especially necessary for those who have experienced significant trauma in their lives. When a traumatic event happens (or repeatedly happens) to a child, the experience is “too much” to process, but the child has no choice but to try and carry on with their lives as best they can. This requires the ability to “forget” what happened. This is accomplished by storing the memories and sensations of the event in a different part of our brain so that we can carry on with the task of daily life. It is as if we offload those memories to one part of the self and then exile them to “the basement”, in order for us to move on. This is a brilliant strategy and we must be grateful that our brains come equipped with this feature because otherwise we would be paralyzed and unable to move forward after a traumatic event. This compartmentalization strategy, however, does have consequences. Those exiled and neglected parts still bear the burdens of the past, and may become easily triggered by present day events.
These confusing symptoms are often what bring trauma survivors into therapy in the first place, and it becomes helpful to start viewing the symptoms as communications from younger parts of us that are not doing well and therefore flooding us with their emotions. The task of therapy is to begin learning how to attend to these young parts of the self and offer them the care and nurturance they need in order to heal.
Could you talk a little about post traumatic growth?
This is a somewhat newer area of research that is coming about, and it is quite interesting. My understanding at least is that this is the idea that some people claim positive psychological changes due to facing adversity and challenges in their lives. It is the idea that while traumatic events and adversity are never desired or welcomed, these challenging experiences nonetheless hold the opportunity for people to experience new growth, inner strength/resiliency, and aspects of the self previously undiscovered. Many people report a radical shift in perspective about their lives and the nature of life itself after working through their traumatic past. Rather than seeing themselves as victims in a tragic life story, they begin to see themselves as survivors capable of overcoming the worst that life has thrown at them.
I find this a helpful paradigm shift. In our day and age it is sometimes easy to forget that we humans are incredibly resilient creatures capable of overcoming tremendous hardship. This is especially important to remember for those trauma survivors who hold toxic beliefs about themselves as “weak”, “defective” or “ruined”. My only worry about this idea is that people will use it to cover over or dismiss the reality of their abuse, and may avoid the necessary journey into grief that must accompany trauma treatment.
Do you often encounter people holding toxic believes about themselves?
This is probably the most common issue that I encounter as a therapist, but especially for those clients who have experienced any sort of trauma. These toxic beliefs about our self as “disgusting”, “defective”, “unlovable”, etc. are the voice of shame. I would describe the experience of shame as like being in a trance. When you are in this trance, your mind, body and soul come under attack and become weighed down by accusations that you are inadequate, broken and beyond repair. It is a terribly painful state to inhabit, and equally difficult to shake yourself out of.
Shame also sets us up for self-contempt, which is like an internal civil war between parts of our self. This war often goes unnoticed because of how subtle it can be. Freedom requires tuning into the ways we attack our more vulnerable parts, and instead work to offer those parts care rather than contempt.
Talk about choosing curiosity over contempt.
This may be somewhat of an overstatement, but sometimes I think this is a majority of what I help clients with: choosing curiosity over contempt. So many of us come into therapy looking to “get rid of”, “eliminate” or “control” problematic symptoms. This makes sense, of course. After all, who wants to continue living with depression, panic attacks, or compulsive behaviors of any kind?
However, I believe we have to first become curious about what our symptoms may be trying to tell us. Symptoms are like signposts pointing us to the wound, and subsequently, towards healing. If we listen to our symptoms rather than trying to frantically get rid of them, they will have much to tell us about what those parts of us need in order to heal. Often though, repeated unsuccessful attempts to manage or control un-welcomed symptoms leads to increasing hatred of those parts of us. This contempt further separates and internally divides us.
Rather, the way forward is to learn to increasingly bring curiosity and the intention to nurture those young, exiled parts in us that are crying out for help. This is the only way I’ve found that actually brings a sense of wholeness and healing.
You can connect with Tyler here
